As patients, we generally do not think too much about emergency care until we face a situation that forces us to call 911. However, emergency care, which is a critical part of our medical system, warrants our attention. I recently spent some time in the emergency room (ER) and it was an interesting and frightening experience, because the ER is not functioning the way it should be on many fronts. The reasons are complex and not easily solved. They include the following:
- The ER has become a dumping ground for every patient who does not have access to basic health services, or a primary care physician to turn to when feeling ill or running a fever, including the uninsured, and the homeless. When I was wheeled into the ER by the EMTs recently, I saw at least 25 people lined up along a wall waiting to get into a room where they could receive care. Many of the same people were still lined up when I was leaving the ER, three hours later.
- According to a study conducted by the National Institutes of Health in 2020, the American Medical Association Physician Masterfile data set showed that there were 48,835 clinically active emergency physicians who designated emergency medicine as their primary or secondary specialty. Of those, the median age was 50 years. Overall density of emergency physicians per 100,000 population was 14.9. Most emergency physicians were in urban areas (92%), only 2,730 (6%) were in large rural areas and 1,197 (2%) in small rural areas. As of May 2024, there were 582,296 emergency medicine specialists active in the United States, and most of them were men, also with a median age of 50. Most emergency physicians located in rural areas (71%) had completed their medical training more than 20 years previously.
National Study of the Emergency Physician Workforce, 2020 by the NIHChristopher L Bennett 1, Ashley F Sullivan 1, Adit A Ginde 2, John Rogers 3, Janice A Espinola 1, Carson E Clay 1, Carlos A Camargo Jr DOI: 10.1016/j.annemergmed.2020.06.039 Pub Med
- It is obvious from these statistics that the United States is experiencing a shortage of ER doctors, particularly in rural areas: The number of new residents in emergency medicine residency programs has decreased significantly since 2021. In 2023, 555 emergency medicine residency positions went unmatched, a 253% increase from 2022. The reasons why emergency medicine has become less desirable include the impact of COVID-19 and the unbelievable pressure it put on the ER doctors, economic workforce projections for the future, increasing economic control by contract management groups (CMGs). The growing clinical demands on ER docs are outpacing pay, and their student loan burdens are enormous. Physician suicide, inadequate staffing to support the doctors and growing malpractice exposure are all factors.
- When I was in the ER, I never saw a doctor. I saw a very competent nurse and a competent physician assistant. I was not a trauma case or a cardiac or stroke patient, so apparently there was no need for me to see a doctor. However, in past experiences, which were also not trauma or life -threatening, I saw at least one doctor and often more than one.
With an increasingly aging population in the U.S. this is an alarming, growing problem, especially for rural areas where there are also increasing numbers of hospitals closing. Thus, the question becomes, “who is going to take care of the patients who rush to the ER because they have no other place to go for care? “
This problem is for the healthcare industry along with the Department of Health and Human Services to solve. One solution would be the expansion of community health centers throughout rural and urban America to serve the poor, uninsured, homeless and underinsured populations who have such limited access to basic health services and default to the emergency room. Other solutions would be a focus on lessening the burden of costly medical education to all medical students and more attractive payment packages to lure more Med school graduates into ER and primary care medicine. One thing is certain. We must act quickly to address this problem before the system implodes and people begin to die in the ER corridors. We are, after all, the richest, developed nation in the world. It is time to begin acting like it when it comes to critical health services.